Case No. EWFC-57

88.On the 9th May 2022, B was being mixed fed by breast and bottle, as A told me that B was really struggling to latch on. By the next day, at the initial midwife visit, A reported that B was feeding well. By the 20th May, the midwife referred B to A&E due to the lack of weight gain. The parents attended a review with Ms. W, specialist feeding advisor. The notes read, Attended with both parents. Reported to be very difficult to latch onto the breast initially. Lots of pushing against the breast and getting upset, which mum said could be typical. Advice given on how to position and latch her correctly as parents were pushing B onto the breast from the back of her head, and not allowing for a backwards head tilt. Once she was fixed, she fed really well – all signs of active and effective feeding seen – chin deep in breast tissue, strong jaw movements, rhythmic suck/swallow patterns and content at the breast. No obvious problems seen. However, when discussing feeding patterns with parents, they reported that she could go up to four hours in the day without a feed and overnight they allowed her to sleep, and she could sleep up to five or more hours without a feed. Advised that the problem was not with the latch but with the fact that she was not being fed often enough – advised to feed three hourly as a minimum even if it meant waking her and encouraging more feeds at night due to prolactin levels. Explained that more frequent feeding would not only help with weight gain but also relieve mum’s engorgement and, in turn, make latching on easier. Reassurance offered that she did not have to feed from both breasts but to always offer the second one just in case. A member of the midwife community team was to reweigh in 48 hours. 89.Unfortunately, the court was not able to hear directly from Ms W, due to her own personal circumstance meaning that she was unable to attend court to give evidence. Without doubt, she would have been able to offer valuable evidence in relation to the specific advice that the mother was being given, and her view as to the mother’s willingness to accept that advice.90.The mother accepted that she took from this meeting that she should try to cluster feed and at a minimum level of every three hours, so that she produced more milk. From that time onwards, A told me that she would breast feed B, would then offer the other breast. A then said that she would also offer her a ‘top up’ feed of expressed milk when she had produced using a breast pump. She kept a log for her own purposes. A was clear that her ‘main intention’ was always to fully breast feed her baby, and it was obvious from her evidence that she regarded this advice as ‘temporary’ whilst she got into a routine that suited her and B. 91.By the 25th May, B was slowly increasing in weight, but was still 9% below her birth weight. She was advised to continue to feed every two to three hours and to express breast milk with which to top up. 92.During this time, the feeding team were messaging and video calling the mother in order to check on her progress. On the 30th May, Mother’s friend called WP messaged the mother, and mother reported to be ‘exclusive breastfeeding’ and then went on to say that “I have started feeding her properly from last Friday.” 93.A told me that between the appointment on the 25th May and the 20th June (B’s six week check with the GP) she was expressing and offering top up milk. From the point of the GP consultation, she felt that her milk production was good enough and so she stopped expressing or topping up in any way. 94.A spoke to a friend via text message about being ‘tortured’ by midwives, but she explained to me that she felt overwhelmed by the different advice that she was receiving, including from her friends. She did not like using the breast pump, although she was very clear in her evidence that she had used it. 95.Dr Ward was asked the opinion about B’s failure to thrive. It was clear that in the absence of an organic cause, the reality was that B was not intaking sufficient calories. 96.RY, health visitor told me that, from her perspective, there was nothing in the notes that would suggest that the mother was not receptive of, and accepting the feeding advice given. But the fact that B immediately put on weight once admitted to hospital might suggest that she was not. But of course, she was also switched to bottle feeding at that same point. 97.Dr Ward has years and years of experience behind her. My impression of her evidence was that she was sympathetic to the position of the mother, particularly, and that it was obvious that she was encouraged throughout those first few weeks to persevere with breastfeeding, despite the faltering growth. Dr Ward told me that advice given to parents can be conflicting 98.A has accepted that she scoured the internet for parenting advice but would also search for things about which she had no reason to believe were relevant to her baby. But those searches do indicate that A was incredibly concerned for B, was acutely aware that feeding was difficult, and that she wanted to do everything that she could to help her. A told me in evidence that the ‘feeding issue’ was always on her mind. 99.I entirely accept that there are emotional and physical complexities related to being a first-time mum, desperately wanting to breastfeed, and receiving conflicting advice as to the ‘best’ way to go about it. It was obvious from the mother’s evidence that she did not want to use formula feed, which she believed increased the chances of B being sick, and that she was determined to breast feed. It was also apparent that she did not enjoy using the breast pump and stopped using it as soon as she could. By the time that she did that, B was gaining weight, although not very quickly. Lots of mothers persevere with breast feeding through thick and thin because they want to do the best that they can for their baby. Feeding a child must involve a degree of personal choice, and I am not persuaded that the care provided by the parents (and specifically the mother) fell below that of a reasonable parent. Had the medical professionals strongly advised bottle feeding, stopping breast-feeding or using formula at certain times, and the parents had objected, they may well have been criticised. But that was not the case in relation to B.100.That is my judgment.